Thursday 21 June 2012

Induction & Alternatives to Induction of Labour

This article was first published on
The Vegetarian Experience on 30th November 2011

Recently a lady in my local area was looking for advice on Induction of Labour via our local parenting Egroup.  As a student Antenatal teacher, I have spent a lot of time researching, gathering information about Induction and also in consultations at our local unit discussing Induction. After receiving some positive feedback to my response, I thought I would blog about it too.

DisclaimerI am offering information to help women and partners make their own informed decisions about Induction, and so this information should not be seen as a substitute for medical advice.

'I'm currently 40+5 and after a 2nd sweep it looks like I may be induced in the next week which I want to avoid if possible. What can I do to avoid being Induced?'

There are different things that you can do safely to avoid being induced if you do not wish to be. Being induced does have a big impact on your birth and means that you have to go to the Consultant Led Unit rather than birthing in a MLU or at home.  Many hospitals and midwives are often keen to reduce their induction rates and so may be open to offering alternatives to induction. If you are faced with someone who is not, you may request a practitioner who can accommodate you.

Firstly, how sure are you of your dates? You may not actually be 42 weeks by your dates when you are 42 weeks by the hospital dates. Your EDD is estimated on an average pregnancy being 28 days or 4 weeks long from the first day of you LMP. It also assumes that you have a 28 day cycle and ovulated on day 14. So if your cycle or date is out, then the EDD is less likely to be precise, so you may have been booked for induction even though technically you may not be overdue by your own dates.  Only 5% of babies arrive on their EDD, 5% come early and 80% of babies arrive within two weeks of their EDD. 10% would come later if they were not induced.

So is your date actually the hospital date or do these differ? 

Things to consider doing before induction

You could request a sweep or multiple sweeps from your midwife to see if this will kick things off before induction. 

Other things you can do to aid the start of natural labour:
  • Go for a long walk. (I walked twice around our local lake to kick off each of my labours).
  • Adopt Upright, Forward and Open positions. Sit forward on a birth ball, in a chair or on the floor to get the baby well engaged in the pelvis.  
  • Using a birth ball can help aid natural labour and getting the baby into a good position. Bounce on a birth ball or roll your hips around and forward and back to get the baby well engaged in the pelvis.
  •  Don't sit in a recumbent position on the couch as this can lead to the baby adopting a posterior position and may cause back labour. 
  • When sleeping, lay on your left side to help get your baby into a good position. The ideal position for labour is LOA which means that the back of the baby's head is facing your left hip. By laying on the left side, gravity will aid it to naturally do this.
  • Clary sage can help to stimulate contractions. You can use it in a carrier oil for massage, burn it via an oil burner, or add a few drops to your bath. Always consult an Aromatherapist or midwife before using and definitely DO NOT USE BEFORE TERM.
  • Most importantly RELAX. Try to think about if there is anything that is mentally preventing labour from starting. If there is, try to think how you can resolve this block as sometimes labour can be subconsciously prevented from starting.

What to do if you reach the date of your Induction

If you do get to 40 plus 10, 12 or 14 (Check your local hospital guidelines), you do not have to automatically accept induction if you do not wish to. You could go to the antenatal clinic or ward and request monitoring to see how healthy the baby is.  Staff would typically scan to check the position of the baby, check the blood flow to the placenta and also have a look at the amount of amniotic fluid surrounding the baby to see whether they think every thing is still ok. A midwife or doctor would assess your overall health, check your BP, and Urine, check for swelling and have a look at how well you and baby are functioning. 

Staff should be able to come up with an individualised plan of care at your request. You can request daily monitoring post term plus 12 or 14 and liaise with your health care providers to see how things are looking. If all is looking well and your baby is still ok, you are well within your rights to request waiting to go into labour naturally. However, if based on medical advice, all is not ok and you, the baby, or the body fluids are not looking good, then its a no-brainer to just go for the induction and get your baby out safely.

Some hospitals may offer an Induction of labour information session from 38 weeks plus which can cover the ins and outs of induction, the process, and induction choices in more detail. Contact your local unit to see if they offer this service if it's looking like induction is going to become an option for you.

Is my risk of stillbirth increased after 42 weeks?

There is little evidence of stillbirth rates past 42 weeks as so few women allow their pregnancies to go past 42 weeks. The most-cited statistic about post-dates babies (that their risk of stillbirth "doubles after 42 weeks") comes from a 1958 study – a time when mortality rates were 10 times what they are now. Also, induction is hardly risk-free: it carries higher rates of caesarean, uterine rupture, foetal distress and maternal haemorrhage.

This is the official line from NICE = The National Institute for Clincial Excellence:

Although the risks of fetal compromise and stillbirth rise steeply after 42 weeks, this rise is from a low baseline. Consequently, only a comparatively small proportion of that population is at particular risk. Because there is no way to precisely identify those pregnancies, delivery currently has to be recommended to all such women. If there were better methods of predicting complications in an individual pregnancy, induction of labour could be more precisely directed towards those at particular risk. Research is needed into racial differences in the UK to identify the possible differences in the distribution of perinatal risk specific to gestational weeks and possible benefits of intervention before 41 weeks.

Average Stillbirth rates UK per 1000 pregnancies according to NICE based on 171,527 births

39 weeks 0.5
40 weeks 0.9
41 weeks 1.3
42 weeks 1.6
43 weeks 2.1

I hope that you have found this information helpful if Induction is something you are considering. Induction can be a positive process and is the right choice for some people. You can still have a straightforward labour if you are induced in many cases, although research has shown that Induction does lead to higher incidences of intervention and Caesarean births. 

If you are induced, using the upright, forward and open positions that were discussed early can enable gravity to give you a helping hand. It can help to find a midwife  in the CLU who is happy to support you in your birth plan of choice, especially if you were hoping not to have an epidural or lots of interventions. If you are being monitored, request 20 minutes of monitoring and then 20 minutes off to try and enable you to move around, or a monitor which will accommodate you being able to move around. You can still use breathing, visualisation and other techniques to assist labour whilst being induced.

Being induced does not mean that you are tied to staying on the bed and laying in a recumbent position. You can still achieve the birth that you were hoping for with induction in many cases,  Induction just means that you  have to take a slightly different path to achieve it.

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